This application proposes a program of research, development, and evaluation for design, collection, and use of consumers' assessments of health care for informing health care choices and quality improvement. The specific goals of the program are to: 1) develop and test CAHPS survey products, 2) maintain existing CAHPS surveys and materials related to CAHPS survey administration; 3) develop and maintain materials related to reporting CAHPS survey results; 4) design and implement quality improvement studies using CAHPS data; and 5) promote CAHPS products. The methods to be used will include focus groups, cognitive interviewing, interviewing of expert informants, and field tests of draft surveys. Standard psychometric statistical techniques will be used to assess quantitative data. Web-based experiments will be used to assess reporting strategies. The applicants are a consortium of experts in consumer survey design, report development, experimental assessment of consumer perceptions and medical care choice behavior, quality improvement, evaluation research, and community-based dissemination methods from the School of Public Health, Yale University, Massachusetts General Hospital/Partners Healthcare System and the Harvard Medical School, the Center for Survey Research at the University of Massachusetts, and several nationally known independent researchers and consultants. This consortium proposes maintaining continuity in the CAHPS development process by continuing critical activities and well established collaborations from the CAHPS I, CAHPS II, CAHPS III and Centers for Medicare & Medicaid Services (CMS) projects, while strengthening the team to bring new skills, perspectives and expertise to the project. The team has maintained close contact with several collaborating demonstration sites and has established relationships with public and private organizations that share an interest in refining and assessing CAHPS products for improved decision making and quality improvement.